The Integration of Religion and Spirituality Into Treatment of Psychopathology Curriculum

1. The Integration of Religion and Spirituality Into Treatment of Psychopathology Curriculum Gina Magyar-Russell, PhD*, Rev. Joseph A.Stewart-Sicking, EdD, and Sharon E. Cheston, EdD Loyola University Maryland * Correspondence should be addressed to Gina Magyar-Russell, Department of Pastoral Counseling, Loyola University Maryland, 8890 McGaw Rd, Suite 380, Columbia, Maryland, 21045. E-mail: gmmagyarrussell@loyola.edu.

2. Learning Objectives Students will acquire: • a theoretical context for evaluating distinctions between religion and spirituality • a rationale for religious and spiritual assessment and intervention • a basic framework for assessing and addressing religious and spiritual issues • Skills to facilitate applying knowledge into practical clinical skills (via case study)

3. Defining Religion and Spirituality • Spirituality was not distinguished from religiousness until the rise of secularism (Turner et al., 1995) • Definitions of both religion and spirituality depend on approach: • Substantive – focused on beliefs, emotions, practices (content) • Functional – the function that religiousness serves in the life of the individual (purpose) (Pargament, 1997)

4. Defining Religion and Spirituality Contrasts between Traditional and Contemporary Approaches to Religion and Spirituality (R&S): Hill et al., 2000

5. Defining Religion and Spirituality Popular view: Constructs are overlapping, with spirituality larger, and each having unique, non-overlapping qualities Take Home Point: Try not to get too caught up in the theoretical definitions (unless you are doing research in this area); rely more on what religion and spirituality mean to your client

6. Why Assess Religion and Spirituality? • Understand client’s worldview and improve ability to work with the client effectively and sensitively • Is client’s religious/spiritual (R/S) orientation healthy or unhealthy and does it impact the presenting problem? • Can client’s religious and spiritual community be used as a resource? • Can R/S interventions be used in therapy? • Are there unresolved R/S doubts, concerns, or needs that should be addressed in therapy

7. Assessing Religion and Spirituality • Communicating an • openness to learning Setting the Stage for Spiritual Dialogue • Communicating an • openness to sharing Pargament , 2007

8. Assessing Religion and Spirituality Look for: Signs of Spiritual Resources Signs of Divine Struggles Signs of Intrapsychic Struggles Signs of Interpersonal Struggles Setting the Stage for Spiritual Dialogue Initial Spiritual Assessment Pargament, 2007

9. Assessing Religion and Spirituality The importance of religion and spirituality to the patient “ Do you see yourself as a religious or spiritual person? If so, in what way?” The salience of religious or spiritual affiliation of the patient “Are you affiliated with a religious or spiritual denomination or community? If so, which one?” The relevance of religion and spirituality to the problem “Has your problem/health affected you religiously or spiritually? If so, in what way?” The relevance of religion and spirituality to the solution “Has your religion or spirituality been involved in the way you have coped with your problem? If so, in what way?” Pargament, 2007

10. Assessing Religion and Spirituality Another Initial Assessment Approach from the Task Force of the American College of Physicians: Do you consider yourself spiritual or religious? How important are these beliefs to you and do they influence how you care for yourself? Do you belong to a spiritual community? How might healthcare providers best address any needs in this area?

11. Assessing Religion and Spirituality Setting the Stage for Spiritual Dialogue Initial Spiritual Assessment Implicit Spiritual Assessment • Implicit Spiritual Assessment: • Clinician raises questions that hint at the possibility of a deeper dimension for the client • Clinician should be sensitive to spiritual responses from their clients Pargament, 2007

12. Assessing Religion and Spirituality * Setting the Stage for Spiritual Dialogue Initial Spiritual Assessment Implicit Spiritual Assessment Explicit Spiritual Assessment • Explicit R/S Assessment: • Clinician focuses directly and extensively on the place of R/S in the client’s life by : • Asking spiritual questions - Placing client in context • Gathering R/S information quantitatively - Attending to the nonverbal • - Gathering R/S information in other ways *= may jump to explicit spiritual assessment from initial assessment as indicated Pargament, 2007

13. Addressing Religion and Spirituality • Basic Rules of Thumb: • Tailor spiritual resources to the client (i.e., use of prayer as outlined by Cheston & Miller, 2011) • It takes time and practice to reap the benefits of spiritual resources • Handle spiritual resources with care • Work within one’s own professional and personal boundaries • Consider referral to, and/or co-treatment with, a clergy member or religious leader Pargament, 2007

14. Case Study for Discussion • 66 year old, married, White female • Describes self as “devote Catholic,” attend daily mass as often as possible, serves as a Eucharistic minister at her church • Referred by her primary care physician due to “a recent exacerbation of symptoms of anxiety and chronic, excessive worry and guilt” • History of an episode of OCD 30 years earlier, in full remission (had been obsessed with termites; compulsion for checking for termites in the wood of her home for approx. 3 years)

15. Case Study – Cont’d Intake assessment reveals: • Has thoughts consistently throughout the day about regrets, guilt, and past conversations and experiences (including events > 30 years ago • Has distressing intrusive words/thoughts enter her mind in relation to Mary (“c_ _t”)* and Jesus (“d_ _k”)* when trying to pray • Uses rituals to attempt to get rid of thoughts • Reports somatic symptoms including nausea, loss of appetite, difficulty sleeping, headaches, weight loss

16. Case Study – Cont’d Issues for discussion: • Differential Diagnosis: Scrupulosity, GAD, or OCD? • Prefers Catholic therapist. Is this important/necessary? • How might “implicit spiritual assessment” look with this client? How about “Explicit spiritual assessment”? Exercise: Working in groups, develop hypothetical details of this case further and attempt to answer the questions in bullets 2-5 on slide #5